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Date of last update: 10/04/2017.

Forum Name: Neurology Topics

Question: Double vision (binocular diplopia) MS or MG or ?

 Nashtunes - Wed Sep 17, 2008 4:57 pm

I am a 40 year old female. I have intermittent double vision that gets worse when I'm tired or when I get out of hot bath. It goes away when I cover one eye or the other. It is really bad if I have a glass of wine. Eye doctors (two) found nothing wrong with my eyes after multiple tests and sent me home. I sought advice of a neurologist, who was clearly annoyed that my eye docs did not refer me. He ordered blood tests for all sorts of things, (Lyme disease, diabetes, thyroid issues) but suspects mysasthenia gravis (he sees a slight eyelid droop that I do not really see). I had an MRI yesterday (he wants to rule out MS). I looked at it ( I know, I know, I'm not qualified!) and saw what looked like one small bright white spot, but not the white spots that appear on MS scans.

Here's my question: I am otherwise quite healty. The double vision is my only symptom. What is the most likely diagnosis? I am worried that the tests won't confirm or deny anything. What then? What other conditions can cause this symptom? Any other diseases that present with only diplopia?

Any advice you can give re what to expect would be greatly appreciated.
 John Kenyon, CNA - Sat Oct 25, 2008 10:17 pm

User avatar Hi there -

While MS can sometimes announce itself via visual disturbances, and you did spot an opacity on the MRI film, you're going to have to wait for a professional reading of the films to get any useful information in that area. MS doesn't usually herald itself with double vision, however, but more often with blind spots, loss of partial field of vision or frank blindness. On the other hand, MG can often start out with binocular diplopia and one in one form is limited exclusively to the eye muscles. What makes this more likely is your mention of it happening when fatigued, after a hot bath and after ingestion of alcohol, all of which can occur with MG. This doesn't mean it couldn't be caused by something else, however.

The eyelid droop noted by the neurologist could also be suggestive of MG, although it also could be simple Horner's sign with no central cause (this is sometimes seen in people who have had thoracic surgery in the past).

So long as there is no progression of symptoms you are on the right track, and the neurologist should follow you according to your symptoms. If you should begin to experience either balance problems or marked muscle fatigue, let your doctor know at once. (The two are unlikely to occur simultaneously, but one is associated with MS,the other with MG).

Please do keep us updated. Best of luck to you with this.

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